Personal Details



Date of Birth


NI Number

Next of Kin Name

Next of Kin Address

Next of Kin Telephone

Contact Details

House Name or Number


Town or City


Post Code

Home Telephone

Mobile Telephone

Email Address

Bank Details

Bank Name

Bank Account Number

Sort Code

Account Holder

Contraction Details

Agency or Direct Client Name

Contact Name

Contact Email Address


Your Role Title

Contract Start Date

Contract End Date

Monthly or Weekly Payments

Know your customer verification

Leo Consultants complies fully with Know Your Customer legislation, and we are required to take the following details for verification against the electoral register.

Are you registered on the electoral roll at your current address?

If not, please email us a copy of the following in your name dated within the last 6 months:
  • Bank statement
  • Utility Bill
  • Credit Card Statement
  • Rates / Council Tax bill
  • Correspondence from HMRC
  • UK Drivers Licence - photo and paper part must be registered to your current address
Please provide your passport MRZ number

Data protection notice

We will use your information together with other information for self-employment administration and customer services. We will disclose your information to our clients, service providers and agents for these purposes. By signing this form, you give your consent to us processing your information, including sensitive personal data, whether obtained from you or another source, for the above purposes. You also consent to our transferring information to countries which do not provide the same level of data protection as the Isle of Man or the UK if necessary for the above purposes. If we do make such a transfer, we will put a contract in place to ensure your information is protected.

You have a right to ask for a copy of your information (for which we charge a small fee) and to correct any inaccuracies. You should make an application to the Company’s Customer Service Department giving 28 days notice.

To make sure we follow your instructions correctly and to improve our service to you through training of our staff, we may monitor or record communications.

Confirmation consent

I consent to my personal details being held in both electronic and paper format (in accordance with the Data Protection Act 2002) and where necessary shared with carefully selected third parties for the purposes of providing you with the best possible service.

I declare that the information given here is accurate and that I have not willfully withheld any information, nor falsified information that would disqualify my application.

I confirm that I have no criminal convictions, which would reasonably affect the decision to allow me access to the Location(s), the Agency, or End User as identified in any Assignment Systems or to fulfill the Assignment.



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